机械支架介入取栓联合静脉溶栓治疗老年急性脑梗死临床疗效及对患者神经功能的影响

摘要

目的:对比机械支架介入取栓联合静脉溶栓与动静脉联合溶栓治疗老年急性脑梗死 (ACI) 的临床效果及对患者神经功能影响.方法:采用随机数字分组方式将120例入选的ACI患者均分为两组, 对照组在常规对症处理基础上实施rt-PA动静脉联合溶栓治疗;观察组则在rt-PA动脉溶栓基础上, 实施机械支架介入取栓治疗.对比两组治疗1个月后临床效果及TIMI血流分级情况;评估两组治疗前及治疗后1个月NIHSS和mRS评分, 测定其血清骨桥蛋白 (OPN) 、氨基末端B型尿钠肽前体 (NT-proBNP) 、超氧化物歧化酶 (SOD) 、丙二醛 (MDA) 水平变化.记录两组治疗期间不良反应情况.结果:观察组ACI患者临床疗效及TIMI血流分级均明显优于对照组 (P<0.05) .治疗后1个月, 两组NIHSS、mRS评分和血清PON、NT-proBNP、MDA水平均明显降低, 血清SOD水平明显升高, 且观察组两项神经功能评分及血清学指标变化均明显优于对照组 (P<0.05) .两组治疗后24h内颅内症状性出血率间差异无统计学意义 (P>0.05) .结论:动脉溶栓治疗后血管未通ACI患者接受机械支架介入取栓治疗可有效促进患者神经功能恢复, 调节机体神经功能相关因子表达, 抑制机体氧化应激反应, 患者TIMI血流分级良好, 临床效果显著, 安全性高.%Objective:The clinical effect of interventional thrombectomy combined with arteriovenous thrombolysis in the treatment of elderly patients with acute cerebral infarction (ACI) and its influence on neurological function.Methods:120 patients with ACI were divided into two groups by random number grouping.The control group was treated with rt-PA arteriovenous combined thrombolysis on the basis of routine symptomatic treatment.The observation group was treated with mechanical stent intervention and thrombectomy on the basis of rt-PA arterial thrombolysis.The clinical effects and TIMI blood flow grading after 1 month of treatment were compared between the two groups.The NIHSS and mRS scores of the two groups before and 1 month after treatment were evaluated, and the changes of serum OPN, NT-proBNP, SOD and MDA levels were measured.Adverse reactions were recorded during the two treatment periods.Results:The clinical efficacy and TIMI blood flow grading of the observation group were significantly better than those the control group (P<0.05).One month after treatment, the scores of NIHSS, mRS and the levers of serum PON, NT-proBNP and MDA were significantly decreased, and serum SOD levels were significantly increased (P<0.05), and the changes of neurological function scores and serological indexes in the observation group were significantly better than those in the control group (P<0.05).There was no significant difference in intracranial symptomatic bleeding rate between the two groups (P>0.05).Conclusion:Intra-arterial thrombolysis after vascular access to ACI patients undergoing mechanical stent interventional thrombectomy can effectively promote the recovery of neurological function, regulate the expression of neurological function-related factors, inhibit the body's oxidative stress response, patients with TIMI blood flow classification, clinical results are significant, high security.